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| DermKnowledgeBASE | ONTODerm - An Ontology
| Slise | Charm
| Laser Hair
Removal model |
DermaMan | Ebook
|English: Skin layers (Photo credit: Wikipedia)|
Sorry for going back to the skin imaging theme once again. During Dicoderm
discussion, we discussed about the growing importance of photodiagnosis (diagnosing dermatological condition from an image, without actually seeing the patient). We realised that we may be good at recognizing large and complex patterns but we may be poor at quantifying and assessing the subtle differences. This makes photodiagnosis a difficult skill to master and it may be different from clinical diagnosis in-vivo. In photodiagnosis large and complex patterns are often hidden, with subtle color difference cues available in abundance. An organized crowdsourcing platform for photo-diagnosing is taking shape here in dermgrandrounds
. But I will blog about it in detail later.
When I explored the color space for skin tone assessment (CHARM
), I considered the possibility of some diagnostic information being hidden in the color space matrix. I even discussed it with few of my friends ( SK and +Feroze Kaliyadan
). (BTW All the best SK with your new baby IDS
, I just saw the website
when I googled your name). I wanted to subject the data to some machine learning algorithm such as a tree classifier or SVM. But I didn’t have enough data.
Korean scientists from the Seoul National University College of Medicine and Seoul National University Bundang Hospital
, have done just that. A decision tree with enough specificity to differentiate erythrotelangiectatic rosacea, papulopustular rosacea and seborrheic dermatitis has been published in BJD recently (1) (Print version may not be out yet). A full five peels
to this research. (OK, I am biased :) Hopefully the research team will someday see my CHARM
Here is a short but useful review on selective hair therapy.(2) The authors argue that novel technologies that could improve guidance into hair follicles (= higher selectivity, sparing of unaffected tissue), retention (= reduced application frequencies, increased and prolonged exposure to the drug) and protection from degradation in the skin environment is already available. But they are yet to become effective products. Are we obsessed with Amanda’s Apple
1. Characteristics of subjective recognition and computer-aided image analysis of facial erythematous skin diseases: A cornerstone of automated diagnosis. Choi, J W; Kim, B R; Lee, H S; Youn, S W (2013) The British journal of dermatology [Pubmed
2. Selective hair therapy: bringing science to the fiction. Vogt, Annika; Blume-Peytavi, Ulrike
(2014) Experimental dermatology. vol. 23(2)
p. 83-6 [Pubmed
What is peel score?
Read more »
Labels: CHARM, DICODerm, Erythema, Hair, Rosacea, Seborrhoeic dermatitis
Sonography and Microscopic MRI of Skin
|Magnetic resonance imaging (MRI) series of a human head (Photo credit: Wikipedia)|
Dermatology Image Tagger Version 2.0 is released. (Download here
) This version introduces encryption for all tags except date. It reduces the speed of search, but will be more secure. Why am I so paranoid about patient privacy when you see patient photographs being posted all the time in some facebook groups? Here is the reason.(Dermatology Clinic Hit With $150,000 HIPAA Penalty
In the DICODerm initiative
we are trying to adapt the radiology image management tools to dermatology. Recently I came across two articles, that could introduce another dimension to this patronage. One dealt with the Sonography of Acne Vulgaris.(1)
The authors conclude ”facial acne vulgaris often involves deeper tissues, beyond the reach of the spatially restricted clinical examination
”. However it is important to demonstrate at most the clinical utility of it in the management of acne vulgaris. I feel there is a risk of channeling medically essential services to less critical situation especially in resource deprived areas.
Another article introduces a dynamic new concept of “Microscopic MRI of skin”.(2)
Though it is still early times, this could well develop as a “non-invasive” skin biopsy technique, with potential for a huge clinical impact. Hope Dr Laistler and his team can convert their HTS coil into a useful tool in a dermatologist’s armamentarium.
(1) Wortsman, Ximena et al. "Sonography of Acne Vulgaris.
" Journal of Ultrasound in Medicine 33.1 (2014): 93-102.
(2) Laistler, Elmar et al. "In vivo MR imaging of the human skin at subnanoliter resolution using a superconducting surface coil at 1.5 tesla.
" Journal of Magnetic Resonance Imaging (2013).
Labels: Acne vulgaris, Magnetic Resonance Imaging, Ultrasound
The Loyalty of Anatomy
|nerves of left upper extremity (Photo credit: Wikipedia)|
The medical knowledge is never static. Most of the drugs we prescribe today were not even there few years back. Personalized medicine is just around the corner, though he is taking a lot of time to come out of the corner. Many theories have been shattered and new ones made. As I posted last week, the mitotic activity of the good old basal cells is highly suspicious
Though I never trusted the loyalty of physiology or pharmacology, I used to respect anatomy. Ulnar nerve has remained ulnar nerve over the years. It still remains medial to the triceps tendon and will remain so for ever. So for me anatomy was loyal and reliable. Unfortunately not any more.
In the initial days of my PG, in the first few pages of Moschella, I read about the superficial and deep vascular plexus of the skin. Like most things in anatomy, I believed it without actually seeing it. I trusted Moschella to have seen it all. But this article(1)
make me doubt the loyalty of anatomy in general and also suspect everything in dermatology that I have not seen with my own eyes!
1. Geyer, SH. "The dermal arteries of the human thumb pad." 2013.
Labels: Anatomy, Dermatology
5 things Dermatologists should not do
What happens when the DNA replicates without cellular replication. It leads to formation of ‘polyploid’ cells. Though polyploidy has been noted in megakaryocytes, bone marrow, myocardiocytes and hepatocytes, it has not been described much in skin. A new study proposes that basal keratinocytes may show up to 50% polyploidization, though its functional relevance is not yet known.
AAD followed the footsteps of 42 other specialties and published a list of ‘5 things Dermatologists should not do
’ along with the commentary from Dr. Goldenberg.
Here is a series of intraoral granulomatous foreign body reactions
in patients treated with calcium hydroxylapatite (CHA) or poly-l-lactic acid (PLA)(1)
Evaluating Industry Attractiveness of Cosmetic Dermatology: an India & Middle East perspective.
is gathering steam. Thanks for all the contributions from +Apratim Goel
, +Feroze Kaliyadan
, +Geraldine Jain
and +Sunaina Hameed
. Special thanks to +Feroze Kaliyadan
for the contributions on positioning standards
. Will work on it some more and get some technical expert to have a look. I was actually planning to write several posts on #DICODerm
, but most of the issues I wanted to highlight have already been discussed. So I am starting yet another interesting (probably a little controversial) topic:
If you attend a dermatology conference in India or Middle East, there is a very high probability that you will be surrounded by dermatologist-CEOs (If you are not one yourself). I don’t think you will find that many CEOs in any other specialty. The dermatologist-CEOs have added a unique dimension to the cosmetic dermatology industry and have ended the era of brand monopoly. Can all these dermatologist-CEOs make it big? Unlikely, as in any other business. Can the corporate brands strike back? Depends, on their strategic capabilities.
I am not an MBA, but for the last few months I am surrounded by business minds and I am extending few lessons I have learnt from them to write this series.
My motive is rather selfish. I am just trying to learn how to apply business principles in real world situations in health care. But it may help budding dermatologist entrepreneurs to position their business better. This may also help consumers to make informed decisions too. For a start: Should you, as a consumer consider having your BOTOX® in a brand or an individual clinic? We shall try to answer questions like this in due course.
I shall use the popular Porter five forces analysis
|Illustration of Porters 5 Forces. Illustrates article Porter 5 forces analysis (currently available in 11 languages). (Photo credit: Wikipedia)|
- Threat of new entrants
- Threat of substitute products or services
- Bargaining power of customers
- Bargaining power of suppliers
- Intensity of competitive rivalry
Here are my satirical views on the cosmetic dermatology industry
and my white paper on research methodologies in cosmetic dermatology
What are your views on the cosmetic dermatology market based on the above five forces?
Labels: cosmetic dermatology, Dermatology, India, Middle East
|Listen2Me (Photo credit: beapen)|
During my early days in dermatology, I used to notice a rare condition being written as diagnosis by a senior colleague for few patients on their file. The condition was called GOK. I had absolutely no idea what this elusive condition GOK was, and I asked her one day to learn more about the condition. She explained to me that GOK stands for ‘God Only Knows
’ and we had a hearty laugh.
With every passing year, my GOK moments started to become more frequent and after my transition to Cosmetic Dermatology, everything other than acne and melasma became GOK. I consoled myself that, I was probably undergoing a Benjamin Button retrogression towards the neo Google generation
, who never had to remember anything, as everything is ‘searchable’. But Google was not the panacea for GOK as it was designed for more mundane tasks.
After several months of (GOK how many!) sleepless nights, I think I have succeeded in brewing the right elixir for GOK. Please try this elixir for yourself! Enter a short history of your GOK moments below and click 'process' to see what happens! The actual homepage is here
This is an experimental application for medical professionals and is provided for informational purposes only. This information is not intended to be medical advice or a substitute for professional medical advice, diagnosis, or treatment. Read the full
before you proceed.
You may cut and paste your clinical findings in the box below using medical terms. Please note that any numbers in the text will be ignored. Please avoid adding any confidential patient data.
Example: Multiple, itchy, tender, subcutaneous nodules on abdomen with septal panniculitis.
Labels: Dermatology, Google, Health, Medicine
Digital Imaging and COmmunications in Dermatology: A prelude
I recently read a 2 decade old editorial on digital imaging in dermatology. The editorial started off with a question:
"Why do dermatologists need any imaging techniques for skin, an entirely visible organ?"
|This image shows a Canon EOS 350D digital single-lens reflex camera with a Tamron 18-200 f/3.5-6.3 XR Di II LD lens. Thanks to Andreas Böttger for allowing me to make this photo. (Photo credit: Wikipedia)|
Every time I open my facebook, I see clinical dermatology images posted for opinion, with a good number of comments and likes. Though crowdsourcing dermatological diagnosis in this manner is a grave violation of privacy to me, digital imaging has become an integral part of dermatology practice.
For some dermatologists (like me), the digital photographs are the only contact with the world of lesions. With the growing popularity of teledermatology and (ethical and non-ethical) crowdsourcing, your exposure to digital photographs as a window to your patient is going to increase. This post is actually a prelude to (an attempt at) defining that future of digital dermatology.
The future has many challenges: Standardization, Sensitivity, Privacy and Ethics are just few of them. In this series, I will discuss these challenges from a technical perspective. I dream of a future when ‘diagnosing from digital photograph’ will be an important part of dermatology training curriculum.
|English: National Naval Medical Center, Bethesda, Md., (Aug. 20, 2003) -- Lead x-ray technologist, James Crisler checks a group of recent x-rays on the monitor in the radiology department at the National Naval Medical Center in Bethesda, Maryland. "The change from film to digital imaging has not only saved money, but increases the speed x-rays get to the physicians.", said Crisler. U.S. Navy photo by Chief Warrant Officer 4 Seth Rossman. (RELEASED) (Photo credit: Wikipedia)|
So I have defined the beginning of this journey. I have an endpoint in mind too: A dermatology specific IOD recommendation for WG-19 DICOM.
Don’t worry if you don’t understand the endpoint now. Suffice to say that we will partly follow the specialty with a well defined imaging standard; Radiology, and modify their tools for our domain. At this juncture, the path to that endpoint is less clear to me too! Technical parts of this series will be on my informatics blog
Here is the link to the wiki page
, where I shall collect all the resources, and this is where we shall reach our destiny with your comments and contributions! I have given the name DICODerm (Digital Imaging and COmmunications in Dermatology) for this project. So if you tweet or discuss in #DsB (Dermatologists Sans Borders
), please use the hashtag #DICODerm and feel free to follow me @beapen
Here is a useful preliminary solution to your image organization problems! Dermatology Image Tagger
Disclaimer: I am not a member of NEMA, Medical Imaging and Technology Alliance or WG-19. The opinions mentioned here and internally hyperlinked pages are my own. External sites are hyperlinked in good faith, but does not mean endorsement.
Labels: DICODerm, Photography
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